NCMB 312 | Diseases

Pericarditis

Pain radiating to the neck, shoulder and back. Aggravated by inspiration, coughing and swallowing. Worst in supine and relieve by sitting up and leaning forward

Hemodialysis

medical Intervention of Uremic Pericarditis

Pericardiectomy

Interventions of Chronic Descriptive Pericarditis

Pericardial effusion

complications of pericarditis

Cardiac Tamponade

build up of blood or other fluid in the pericardial sac puts pressure on the heart which may prevent it from pumping effectively

Myocarditis

Viral and chronic alcohol and cocaine abuse, anorexia, pale or cyanotic skin

Endomyocardial Biopsy

Most definite test for myocarditis

Rheumatic Fever

Usually develops after URTI

rheumatic carditis

If the heart is also affected

Endocarditis

Infection of the innermost layers of the heart

1. Carditis- formation of aschoff's bodies

2. Polyarthritis- swelling of several joints

3. Chorea(Sydenhams chore, St. vitus dance) - involuntary grimacing

4. Subcutaneous nodules- marble sized nodules appear around the joints

5. Erythema Margitanum- red, spotty rashes on the trunk that disappears rapidly leaving irregular circles on the skin

Major symptoms of endocarditis

1. History of RF or of pre existing RHD

2. Arthralgia- pain in one or more joints without evidence of inflammation

3. Fever

4. positive ISO titer

Minor symptoms of Endocarditis

1. 2 major manifestation

2. 1 major + 2 minor with supporting evidence of a recent streptococcal infection

JONES criteria

Heart Failure

Inadequacy of the heart to pump blood throughout the body

Congestive Heart Failure

Accumulation of blood and fluid in organs and tissues due to impaired circulation

Congestive Heart Failure assessment

• -Heart sounds will resemble of a galloping horse because fluid backs up into the lungs.

-Lungs sounds are similar to what you heart when blowing back through a straw, in a can of soda

-low sodium diet, fluid restriction and diet high in potassium

Medical management of Congestive Heart Failure

1. Digitalis: Digoxin

- lowers HR(if below 60HR, don't administer)

DIGITALIS TOXICITY- Loss of appetite, N&V, rapid, slow and irreg HR, disturbance in color vision ( bradicardia- earliest signs of toxicity)

2. Dopamine

Inotropic agents for CHF

Calcification

accumulation of calcium salts in the body

Osler nodes (Endocarditis)

Small, painful nodules may be present in the pads of fingers or toes

Janeway lesions (Endocarditis)

Irregular, red or purple, painless, flat macules may be present on the pals, fingers, hands, soles and toes

Roth spots (Endocarditis)

Hemorrhage with pale centers caused by emboli may be observed in the fundi of the eyes

Left-sided Heart Failure

Heart failure that manifest pulmonary congestion

right sided heart failure

Heart Failure that manifest congestion of the viscera and peripheral tissues

Coronary Artery Disease

The major blood vessels that supply heart become damaged or diseased

Plaques

Cholesterol containing deposits and inflammation

Arteriosclerosis

Thickening or hardening of the arterial wall

Atherosclerosis

Common type of arteriosclerosis and plaques form in the inner layer (tunica intima)

Monkeberg's arteriosclerosis or Medical calcific sclerosis

type of arteriosclerosis with the involvement of the middle layer (tunica media) and there is a destruction of muscle and elastic fibers and formation of calcium deposits

Arteriolar sclerosis or Arteriolosclerosis

Marked by thickening of the walls of arterioles

Homocysteine

Block the production of nitric oxide on the endothelium making the cell wall less elastic and permitting plaque to build up

B-complex vitamins rich diet (folic acid) B9 leafy vegetables, pasta, bread, cereal and liver

What lowers homocysteine

total=less than 200 mg/DI.

LDL(bad cholesterol) = less than 100 mg/DI.

HLD (good cholesterol) = more than 40 mg/DI

Normal values of Total cholesterol, LDL, HDL

Angina pectoris

• "Chest pain" of cardiac origin

Angina Pectoris

Most common called manifestation of myocardial ischemia

Reducing anxiety

Prevention of Angina pectoris

Myocardial Infarction

Complete occlusion of the artery

vasospasm

Sudden constriction or narrowing of a coronary artery

Atherosclerosis

Primary factor of Myocardial Infarction

Myocardial Infarction

Sudden coronary obstruction caused by thrombus formation over a ruptured ulcerated plaque, the acute coronary syndrome results

Myocardial Infarction

Occurs as a result of sustained ishemia, causing irreversible cellular damage

Non-ST Elevated MI

The plaques rupture and thrombus formation causes partial occlusion to the vessel that result in injury and infarct to the subendocardial infarct

ST elevated MI (STEMI)

Complete occlusion of blood vessels lumen, resulting in transmural injury and infarct to the myocardium, which is reflected by ECG changes and a rise of troponins

Subendocardial MI

Damage has not yet penetrated through the entire thickness

Coronary artery bypass surgery (CABG)

Surgical procedure in which a blood vessel is grafted to an occluded coronary artery so the blood can flow beyond the occlusion

Transmural infarct

-most serious or severe

-Involves the entire thickness of myocardium

Troponin T

84% sensitivity to MI 8 hours after onset

Troponin I

90% sensitivity to MI 8 hours after onset

Cardiopulmonary Bypass (CPB)

- Procedure that circulates and oxygenates blood for the body while bypassing the heart and lungs.

- maintains perfusion to body organs and tissues and

allows the surgeon to complete the anastomoses in a

motionless, bloodless surgical field.

Obstructive Disorder

category of respiratory disease characterized by airway

obstruction.

760 mmHg

atmospheric pressure at sea level

755 mmHg

intrapleural pressure

Ventilation

- movement of air in and out of the lungs

- gas exchange

Diffusion

Movement of molecules from an area of higher concentration to an area of lower concentration.

intrapulmonic pressure

pressure within the lungs

Perfusion

Amount of blood flow in the pulmonary artery

Thrombolitic medications

Medication that dissolves blood clot

Smoking

Most common cause of Chronic obstructive pulmonary disease (COPD)

chronic obstructive pulmonary disease (COPD)

A disease characterized by airflow limitation that is not fully reversible.

pneumonia

One of the most common complications of COPD

-Hypoxemia and Acidosis

- Respiratory Infections

- Cardiac Dysrhythmias

- Cor Pulmonale

Complications of COPD

COPD (chronic obstructive pulmonary disease)

Characterized by chronic cough, sputum production, and dyspnea on exertion; often worsen overtime.

- Bullectomy to reduce dyspnea

- Lung volume reduction to improve lobar elasticity and function

- lung transplantation.

Surgery for COPD

Bronchial Asthma

- Allergic in nature

- Intermittent & reversible airflow obstruction affecting

the lower airway

- Bronchial edema causes obstructions mucus

secretions cannot get through

Bronchial Asthma

Audible wheezing & high RR (acute episode)

• Wheezing is louder during exhalation

Pulmonary function tests

most accurate test for asthma

Total lung capacity (10 to 12 L)

the maximal volume of gas in the lungs after a maximal inhalation

Residual Volume - 1,200mL

Amount of gas remain in the lungs

Vital capacity (4-6 L)

Amount of gas that can be exhaled

1. β2 agonist: Albuterol (Ventolin), Bitolterol, Pirbuterol,

Salmeterol, Formoterol – Bronchial dilatation, relax the

lungs muscles “rol”. Inhalers

2. Methylxanthines

• Theophylline, Aminophylline, Oxtriphylline]

• Monitor for SE: excessive cardiac & CNS stimulation

(check pulse & BP)

3. Cholinergic antagonist

• Ipratropium (Atrovent)

Bronchodilators for Bronchial Asthma

- Corticosteroids: reduce the edema and open the airway

- Mast cell stabilizer: Cromolyn sodium (Intal); helps prevent atopic asthma

attacks, but are not useful during an acute episode

- Monoclonal antibodies: Omalizumab (Xolair), preventing the release of chemical mediators for inflammation

Anti-inflammatory Agents for Bronchial Asthma

- Corticosteroids:

reduce the edema and open the airway

- Mast cell stabilizer

Cromolyn sodium (Intal); helps prevent atopic asthma

attacks, but are not useful during an acute episode

- Monoclonal antibodies

Omalizumab (Xolair), preventing the release of chemical mediators for inflammation

Acute Bronchitis

- Inflamed primary and secondary bronchi

Acute Bronchitis

Assessment Findings

- Fever, chills, malaise, headache, dry irritating

nonproductive cough (initial) ---- mucopurulent

sputum

Chronic Bronchitis (Blue Bloater)

Prolonged inflammation of the bronchi accompanied by a

chronic cough & excessive production of mucus for at

least 3 months each year for 2 consecutive years

Emphysema (Pink Puffer)

Abnormal distention of the airspaces beyond the terminal

bronchioles and destruction of the walls of the alveoli

• Barrel chest

• Severe dyspnea

• Thin-framed body

Signs & symptoms of Emphysema

Emphysema

- A chronic disease characterized by loss of lung elasticity &

hyperinflation of the lung

- most common COPD

Alpha1 - Antitrypsin Deficiency (AAT)

• is made by the liver and is normally present in the

lungs

• Function: regulates proteases from working on lung

structures

• If deficient, COPD develops even if the person

is not exposed to cigarette smoke or other irritants

Signs/ symptoms

- Bullae/ blebs

- Pneumothorax

Signs/ symptoms of Emphysema

Emphysema

Assessment Findings

• Exertional dyspnea - 1st symptom

• shortness of breath with minimal activity

• Chronic productive cough with mucopurulent sputum

• "Barrel shaped chest"

- lost of hypoxic drive

- 2mL

High flow of O2 may lead to?

Bronchiectasis

- An abnormal and permanent dilatation of bronchi &

bronchioles

- It results from inflammation and destruction of the

structural components of the bronchial wall

Pneumonia

- inflammatory process affecting the bronchioles & alveoli

- Inflamed air spaces filled with fluid

Bronchopneumonia

Infection is patchy, diffuse & scattered throughout

both lungs

Lobar pneumonia

Inflammation is confined to one or more lobes of the

lung

CAP (Community-acquired pneumonia)

- Illness is contracted in a community setting or within

48 hrs of admission to a healthcare facility

HAP (Hospital-acquired pneumonia)/ Nosocomial

pneumonia

- Occurs in healthcare setting >48 hrs after admission

Opportunistic Pneumonia (immunocompromised host)

- P. carinii pneumonia (Pneumocystis jirovecii ), Fungal

pneumonia, pneumonia related to TB

• Productive cough, sputum (rust colored)

• Pain during breathing (patient exhibits shallow breathing)

Assessment Findings of Pneumonia

Semi-Fowler's Position

Position for management of Pneumonia

Pleural Effusion

Abnormal collection of fluid between the visceral &

parietal pleurae as a complication of

- Pneumonia

- Lung CA

- TB

- Pulmonary embolism

- CHF

• Normal: 5-15ml

Transudative effusion

(protein-poor, cell-poor)

- Hydrothorax- accumulation of water/serous fluid

Exudative effusion

(protein rich fluid)

- Pyothorax or Empyema- accumulation of pus

- Hemothorax- accumulation of blood

- Chylothorax- accumulation of lymph and lipoprotein

• Friction rub

• CXR & CT scan - shows fluid accumulation

Assessment Findings of Pleural Effusion

Thoracentesis

mechanical removal of fluid by used of syringe and needle.

Medical management of pleural effusion

- Assist client to an appropriate position (sitting with arms

and head on padded table or in side-lying position on

unaffected side)

- Instruct the client not to move during the procedure,

including no coughing or deep breathing

-

Nursing Guidelines for Pleural effusion

Fractured Ribs/ Sternum

- Common injury resulting from a hard fall or a blow to the

chest

- Automobile & household accidents (frequent cause)

- Sharp end of the broken rib may tear the lung or thoracic

blood vessels